Can an Advanced Computer Program Replace a Doctor at the Diagnostic Stage of Patient Treatment?

1. Can an Advanced Computer Program Replace a Doctor at the Diagnostic Stage of Patient Treatment? Sudeep Sunthankar Spring Valley High School

2. Past Research • Computers help doctors with diagnosis as early as 1969 (Waxman & Worley, 1990) . • 1970: William Schwartz felt that computers could be used to replace doctors completely (Waxman & Worley, 1990). • Schwartz did not produce a program that was strong enough to support his idea (Waxman & Worley, 1990).

3. Current Day Programs • Doctors utilize software to diagnose patients (Scott and Purves, 1998). • Meditel and the Quick Medical Reference (QMR) are two types examples (Federhofer, 2005). • Designed for doctors use (Federhofer, 2005).

4. Influenza C • Most common of the three types of Influenza (AMA, 2004). • Only affects humans and animals (AMA, 2004). • Known as the flu to most people, usually contracted annually (C Health, 2005). • Non Lethal unless infects an already weakened immune system such as the elderly, young children, or people already fighting a disease (AMA, 2004).

5. Fever Shaking Chills Sneezing Headaches Weakness Chest pains Muscle aches Sore throats Dry coughs Influenza C (AMA, 2004) (CDC, 2004).

6. Coronary Artery Disease • Almost 1 out of every 2 males over the age of 40 contract the disease (49%). This is the most vulnerable group (Medline plus, 2005) .

7. Discomfort Heaviness Pressure Aching Burning Short breath Irregular heartbeats Dizziness Nausea Sweating Weakness Pain in the: Chest Left shoulder Arms Neck Throat Jaw Back Coronary Artery Disease (WebMD, 2004)

8. Hypertension • Strongly tied to high blood pressure and high cholesterol. • 120/80 Hg is normal blood pressure • Blood pressure over 140/90 Hg is considered hypertension (Crews, 2005). • Blood pressure at 139/89 Hg is considered prehypertension (Crews, 2005).

9. Obesity Glucose intolerance Stress High alcohol intake High sodium intake High blood pressure (Crews, 2005). 40% of hypertension victims display obesity, which is an easier symptoms of hypertension to identify (Neutel and Smith, 1998). Hypertension

10. Purpose • Discover whether a computer can correctly diagnose certain types of patients better than a doctor. Microsoft Clip Art 2005

11. Materials • Human Subjects • Computer • Microsoft Access • Microsoft Visual Basic • Surveys Picture taken by Sudeep Sunthankar

12. Hypothesis • The computer program, the “Virtual Doctor”, will be able to produce an overall higher percentage of correctly diagnosed patients than the human doctor in the three disorders, influenza C, coronary artery disease, and hypertension.

13. Methods: The Patient Virtual Doctor created in Microsoft Access with a combination of Visual Basic Code. Patient Survey Forms created Once the surveys had been completed, the section that contained the symptoms of the disease was sent to the doctor for diagnosis. The surveys contained a place for the symptoms for the disease and a section for the disease that the patient had suffered from.

14. Patient/Doctor Survey

15. Methods: The Doctor The doctor’s decision had to be made strictly from the symptoms the patient had listed on the survey. The diagnosis was recorded on the survey in a section that was designated for the doctor’s diagnosis Once the doctor’s diagnosis had been made for that survey, the survey was ready to be sent back to the researcher

16. Methods: The Computer An unbiased party then entered the symptoms into the computer. The unbiased party was an individual who did not have access to information about the research such as the purpose of the research. The symptoms could then be entered without any bias or favoritism during this process. Once all the symptoms on a form had been entered, the database informed the individual whether it could make a diagnosis from the information entered. The individual entered the patient’s symptoms by selecting the symptoms listed on the computer screen.

17. Computer Program In Use Pictures taken by Sudeep Sunthankar

18. Experimental Design Diagram Dependent Variable: The number of correctly diagnosed patients by the computer and doctor respectively. Constants: • Area from which patients are collected • Program used to diagnose symptoms • Creator of program • All subjects over the age of 18.

19. Descriptive Statistics-Correctly Diagnosed Patients

20. Descriptive Statistics-Incorrectly Diagnosed Patients

21. Results • The doctor had 40 correct and 5 incorrect. • The computer had 36 correct and 9 incorrect.

22. Results • The doctor had 70 correct and 5 incorrect. • The computer had 51 correct and 24 incorrect.

23. Results • The doctor had 28 correct and 8 incorrect. • The computer had 26 correct and 10 incorrect.

24. X² Summary Table-Doctor Diagnosed DF=2, Critical value=5.991, Chi Square Test Value= 2.67, α= 0.05, P-Value: 0.2636

25. X² Summary Table-Computer Diagnosed DF=2, Critical value=5.991, Chi Square Test Value= 12.25, α= 0.05 P-value: 0.0022

26. Conclusions Variation between patient and doctor diagnosis: • No significant difference between the doctor and patient’s diagnosis. • This means that the doctor’s diagnosis and the patient’s diagnosis agreed. Variation between patient and computer diagnosis: • Significant difference between the computer’s diagnosis and the patient’s diagnosis. • This means that the computer did not produce enough correctly diagnosed patients to statistically match the doctor.

27. Conclusions • The experimental hypothesis, the computer would produce a higher amount of correctly diagnosed patients than the doctor and therefore would be able to replace a doctor at the diagnostic stage of patient treatment, was not statistically proven after conducting a chi square goodness of fit test.

28. Conclusion • The main reason the program was not statistically proven was the fall-off in the coronary artery disease group. • The computer and doctor diagnosis were very close in both the influenza and hypertension groups.

29. Sources of Error • Lack of diversity in disorders • Localized study • Time restraints • Lack of symptoms

30. Future Research • Preference of Doctor or Computer • Test to see if patients prefer the doctor instead of the computer or vice versa. This could have added an extra dimension to the project • Patients able to enter their own data • Producing the program and making it available on the internet

31. Future Research • Larger database • more diseases/ symptoms • more useful and relevant program. • More complex program • treat adults, young children, and the elderly. • Store and monitor patients’ data and medical history • such as blood pressure, weight, and other medical information • when a patient uses the program repeatedly, the program could use previous symptoms and medical history to better diagnose an illness

32. Acknowledgements I Would like to thank: • Mr. Dale Soblo and Ms. Michelle Sutton for their advice, supervision, and advice throughout the study. • Dr. Kalpana Sulhyan for her tremendous assistance to organize and collect subjects for this project. • Nitin Uplekar for his help in creating the database. • All of the human subjects for their participation and cooperation in this research • My friends and family

33. Literature Cited American Medical Association. (2004). Family medical guide (4th ed.). New Jersey: John Wiley and Sons, Inc. C Health. (2005). Flu and Cold. Retrieved September 1, 2005, from http://chealth.canoe.ca/channel_health_features_details.asp?health_feature_id=69&article_id=147&channel_id=39&relation_id=2114. Center for Disease Control and Prevention. (2004). Clinical Description and Diagnosis. Retrieved July 12, 2005, from http://www.cdc.gov/flu/professionals/diagnosis/. Crews, Leigh. (2005). Designing a yoga program for active seniors: how a simple yoga practice can alleviate symptoms of arthritis, hypertension and osteoporosis, three health conditions that typically affect older adults. IDEA Health & Fitness, 2 (4), 56. Retrieved July 22, 2005, from Info Trac OneFile. Medline Plus. (2005). Coronary Heart Disease. Retrieved July 12, 2005, from http://www.nlm.nih.gov/medlineplus/ency/article/007115.htm.

34. Literature Cited Scott, D. and Purves, I.N. (1996). Triadic relationship between doctor, computer and patient [Electronic version]. Interacting with Computers8, 347-363. Federhofer, Judith. (ND). Medical Expert Systems. Retrieved July 13, 2005, from http://www.computer.privateweb.at/judith/name_3.htm#qmr_name. Neutel, J.M. & Smith, D.H.G. (1998). Hypertension: Where have we gone wrong and how can we fix it? [Electronic Version]. American Journal of Hypertension 10, 150S-157S. Waxman H. S. & Worley W.E. (1990). Computer-assisted adult medical diagnosis: subject review and evaluation of a new microcomputer-based system. Medicine, 69(3), 125-137. Retrieved May 2, 2005, from Info Trac OneFile. WebMDHealth. (2004). Heart disease: coronary artery disease. Retrieved May 1, 2005, from http://my.webmd.com/content/pages/9/1675_57851.htm

35. Can an Advanced Computer Program Replace a Doctor at the Diagnostic Stage of Patient Treatment? Sudeep Sunthankar Spring Valley High School